Psoriasis and a Healthy Pregnancy

Find out how working with your doctor and adjusting your psoriasis treatment can keep you and your unborn baby safe.

Being pregnant should be a joyful time, but if you’re a woman
with psoriasis, you may wonder how your psoriasis and its treatment could
affect your unborn child. However, with careful planning and some basic
knowledge, psoriasis is generally safe for both mom and baby. And there’s a
possible bonus: At least for awhile, your psoriasis symptoms might even get
better.

“On average, psoriasis improves during pregnancy,
and pregnancy isn’t affected by psoriasis,” says Mark Lebwohl, MD, professor
and chairman of dermatology at Icahn School of Medicine at Mount Sinai in New
York City and president-elect of the American Academy of Dermatology.

However,
because psoriasis often starts in early adulthood — before a woman
has a chance to start a family — concerns persist about having a safe
pregnancy and a healthy baby with
psoriasis. Here's what you need to know.

Psoriasis, Fertility, and
Genes

First,
psoriasis doesn't affect a man's or a woman's reproductive system. Also, you
can’t pass psoriasis on to your child during pregnancy, delivery, or
breastfeeding. You can, however, pass on genes that put your child at a
slightly higher risk for psoriasis. About 10 percent of people inherit genes
for psoriasis from a parent, but only 2 to 3 percent of people actually develop
psoriasis.

Psoriasis and Low-Birth-Weight
Babies

A woman’s psoriasis may affect her baby in other
ways. A study published in 2012 in the
"Journal of Investigative
Dermatology" evaluated 663 pregnancies, including 162
among women with psoriasis. The risk for complications such as pre-term birth
or low birth weight was nearly double for women who had psoriasis, compared
with those who didn’t have the skin condition.

However, this risk may vary with the degree of
psoriasis. “Some studies show no difference in the rate
of pregnancy complications,” says Keith A. Eddleman, MD, a professor or
obstetrics, gynecology, and reproductive medicine and the director of obstetrics
at the Mount Sinai Hospital. "Other
studies, especially those focused on women with severe psoriasis, show
increased risks for low-birth-weight infants." But more research is needed
on the subject, he says.

Psoriasis
Treatment During Pregnancy

In general, treatment for psoriasis is usually done
with a "step-up approach" — lotions and creams first, special
lights or lasers next, and so on. "This stepwise treatment is the
same for pregnant women," Dr. Eddleman says, "but some of the
medications given for psoriasis treatment shouldn’t be used during pregnancy
due to concerns that they could potentially cause harm to the developing fetus."

Drugs including methotrexate and acitretin should
not be used during pregnancy. "Most biologic drugs are in ‘pregnancy
category B,’ meaning that they should only be used if the benefits outweigh the
risks,” Dr. Lebwohl says. Your doctor can help you find the safest drugs to use
during pregnancy given your particular psoriasis symptoms.

Psoriasis Treatment and
Breastfeeding

You
can breastfeed your baby as long as you avoid taking any psoriasis drugs that
pass through to your breast milk. Just as during pregnancy, though, only the
safest treatments are advised. Psoriasis creams and lotions may be used, but
not around the breast or nipple area. Ask
your doctor which treatments and products are the safest to use.

If
you have psoriasis on your nipples, you can use a moisturizer to protect them. But
know that having nipple psoriasis will not harm your baby.

Psoriasis and Smart Pregnancy
Planning

If
possible, talk to your doctor in
advance about psoriasis treatment and planning for pregnancy. Work together to
get your psoriasis under control as best as you can before you become pregnant.
This can help decrease your risk for pre-term delivery and a low-birth-weight
baby.

Although
many women find their psoriasis gets better during pregnancy, it can get worse
for some, especially after the baby is born. “About half of all women with psoriasis will have a flare in the
post-partum period,” Eddleman says. Talk to your doctor about how to manage
these flares in the weeks after giving birth.

There
are some risks associated with psoriasis and pregnancy, but in most cases they
can be managed by working closely with your obstetrician — as well as
the doctor you see for psoriasis — during pregnancy and delivery. As
long as you plan ahead, there's no reason why psoriasis should prevent you from
having a safe pregnancy and a healthy baby.

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